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4632 Reservoir Rd Nw Washington DC 20007-1917 | |
| (301) 908-4858 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 4632 Reservoir Rd Nw, Washington, District Of Columbia |
| Authorized Official Name and Position | Brian Mathis (CEO) |
| Authorized Official Contact | 3019084858 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4632 Reservoir Rd Nw Washington DC 20007-1917 Ph: (301) 908-4858 | 4632 Reservoir Rd Nw Washington DC 20007-1917 Ph: (301) 908-4858 |
| NPI Number | 1902595754 |
|---|---|
| Provider Enumeration Date | 05/05/2023 |
| Last Update Date | 03/28/2024 |
| Medicare PECOS PAC ID | 0547610461 |
|---|---|
| Medicare Enrollment ID | O20231219000736 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902595754 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Gina Sobretodo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184146243 PECOS PAC ID: 1759613391 Enrollment ID: I20230726003496 |
| Provider Name | Meera Patel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639619497 PECOS PAC ID: 4183953573 Enrollment ID: I20230829003203 |
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